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The Turkish Journal of Gastroenterology
2004, Volume 15, No 2, Page(s) 117-119
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Inflammatory myoglandular polyp: A rare cause of hematochezia
Burçak KAYHAN1, Fikri KÜÇÜKEL2, Meral AKDOĞAN3, Ersan ÖZASLAN1, Tevfik Ali KÜÇÜKBAŞ2, Ömür ATOĞLU4
Ankara Numune Hospital Department of Gastroenterology Clinic1, Ankara
Ankara Güven Hastanesi General Surgery and Gastroenterology2, Ankara
Türkiye Yüksek ‹htisas Hospital, Department of Gastroenterology Clinic3, Ankara
Gazi University Medical Faculty Department of Pathology4 ABD, Ankara
Keywords: Inflammatory myoglandular polyp, hematochezia.
Summary
Inflammatory myoglandular polyp is characterized by inflammatory granulation tissue in the lamina propria, proliferation of smooth muscle, and hyperplastic glands with variable cystic change. The etiology is obscure. Mucous diarrhea, tenesmus, and hematochezia are main symptoms. We hereby report an 80-year-old man with diagnosis of inflammatory myoglandular polyp.
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  • Introduction

    Nakamura first described a new benign colorectal epithelial polyp in 1992, which was termed inflammatory myoglandular polyp (IMGP) (1). Its characteristic histopathologic features are inflammatory granulation tissue in the lamina propria mucosa, proliferation of smooth muscle, and hyperplastic glands with occasional cystic dilatation (1).

    In this report, we describe another case of inflammatory myoglandular polyp in the sigmoid colon.

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  • Case Presentation

    A 82-year-old man was admitted to the emergency service with hematochezia. History revealed right hemiplegia for five years. Colonoscopy showed a pedunculated large polyp (>6 cm) with a reddish smooth surface (Figure 1), and multiple diverticula in the sigmoid colon. Histopathologic examination of the specimen showed inflammatory granulation in the lamina propria mucosa, proliferation of smooth muscle and hyperplastic glands with cystic dilatation (Figures 2a, 2b). The polyp was diagnosed as inflammatory myoglandular polyp based on the characteristic histological features.

    The patient underwent a left hemicolectomy after which all symptoms disappeared.

    Figure 1: Colonoscopic appearance of the polyp
    Figure 2: Both of the figures reveal the pathological specialities of inflammatory myoglandular polyp.Histopathologic examination of the specimen showed inflammatory granulation in the lamina propria mucosa, proliferation of smooth muscle and hyperplastic glands with cystic dilatation

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  • Introduction
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  • Discussion
  • References
  • Discussion

    Inflammatory myoglandular polyp has been characterized as a solitary, non-neoplastic polyp consisting of inflammatory granulation tissue in the lamina propria, proliferation of muscularis mucosae, and hyperplastic glands with variable cystic change (1-6). IMGP is solitary, pedunculated and, rarely, covered by a fibrin cap. Also, IMGP has no association with inflammatory bowel diseases and is located not only in the rectosigmoid, but also in the descending and transverse colon (7). In our case, the localization was in the sigmoid colon.

    Although the etiology of IMGP remains uncertain, Nakamura (1) proposed that chronic trauma from intestinal persitalsis may contribute to the pathogenesis of IMGP. Since IMGP has never been reported to accompany neoplasia to date (1-6) endoscopic polypectomy alone seems to be sufficient treatment. However, our patient had a polyp that was too large for endoscopic removal, and we preferred surgery for this case. On the other hand, there has been controversy about whether IMGP is clinicopathologically distinct from mucosal prolapse syndrome, inflammatory cloacogenic polyp, inflammatory cap polyp, and polypoid prolapsing mucosal folds of diverticular disease (6). Many polypoid conditions throughout the gastrointestinal tract have been thought to be due to mucosal prolapse (8). Also, mucosal prolapse may be the etiological cause of myoglandular polyp. This entity bears similarity to polypoid prolapsing mucosal folds in diverticular disease as reported by Kelly (9). Nakamura pointed to the fact that patients who had myoglandular polyps usually had diverticuli in the sigmoid colon (1). In accordance with this report, our case had multiple diverticula in close proximity to the main pathology. IMGP was composed of inflammatory granulation tissue, hyperplastic glands, and proliferation of smooth muscle in a radial fashion but never showed the villous architecture usually found in the mucosal prolapse syndrome (10). Inflammatory cloacogenic polyp is a solitary, pedunculated polyp with tubulovillous architecture only at the anorectal transition zone (11). Also, it is known that inflammatory myoglandular polyp has to be distinguished from other polyps because of its different clinical features. Mucous diarrhea and tenesmus are the most common symptoms of patients with inflammatory cap polyp (12), while the main symptom of IMGP is hematochezia (1-4). However, the causes of inflammatory myoglandular polyp are still obscure, and further accumulation of cases may disclose their pathogenesis.

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  • References

    1) Nakamura S, Kino I, Agaki T. Inflammatory myoglandular polyps of the colon and rectum: a clinicopathological study of 32 pedunculated polyps, distinct from other types of polyps. Am J Surg Pathol 1992; 16: 772-9.

    2) Griffiths AP, Hopkinson JM, Dixon MF. Inflammatory myoglandular polyp causing ilo-ileal intussusception. Histopathology 1993; 23: 596-8.

    3) Gomez NE, del Rio MJV, Sarasa CJL, Melere CE. Myoglandular inflammatory polyp located in the distal end of rectum. Rev Esp Enferm Dig 1994; 85: 45-6.

    4) Nagata S, Sumioka M, Sato O, et al. Five cases of inflammatory myoglandular polyp. Nippon Shoukakibya Gakkai Zasshi 1998; 95: 145-50.

    5) Bhardwaj K, Mohan H, Chopra R, et al. Inflammatory myoglandular polyp of the rectum. Indian J Gastroenterol 1998; 17: 63-4.

    6) Harada N, Chijiwa Y, Yao T, et al. Inflammatory myoglandular polyp. J Clin Gastroenterol 1999; 29: 104-5.

    7) Bhathal PS, Chetty R, Slavin JL. Myoglandular polps. Am J Surg Pathol 1993; 17: 852.

    8) Bartolo DCC, Warren BF. Refractory solitary rectal ulcer syndrome. In: Dorbrilla G, Bardhan KD, Steele A, eds. Non-responders in Gastroenterology. Milan: Cortina International-Raven Press, 1991; 169-80.

    9) Kelly JK. Polypoid prolapsing mucosal folds in diverticular disease. Am J Surg Pathol 1991; 15: 871-8.

    10) Nakamura S, Kino I. Letters to the editor (authors’ reply). Am J Surg Pathol 1993; 17: 751.

    11) Saul SH. Inflammatory cloacogenic polp: relationship to solitary rectal ulcer syndrome/mucosal prolapse and other bowel disorders. Hum Pathol 1987; 18: 1120-5.

    12) Williams GT, Bussey HJR, Morson BC. Inflammatory ‘cap’ polyps of the large intestine. Br J Surg 1985; 72: 133.

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